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Fuentes-Martín Á, Gregorio Crespo B, Matilla González JM. Spontaneous Pneumothorax During Pregnancy. Arch Bronconeumol 2023; 59:597-598. [PMID: 37487773 DOI: 10.1016/j.arbres.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Álvaro Fuentes-Martín
- Thoracic Surgery Department, Universitary Clinic Hospital of Valladolid, Valladolid, Spain.
| | - Begoña Gregorio Crespo
- Thoracic Surgery Department, Universitary Clinic Hospital of Valladolid, Valladolid, Spain
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Cardoso MC, Raposo MI, Gaio-Lima C, Ferreira P, Cosme P. Primary spontaneous pneumothorax during pregnancy: A case report and review of the literature. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:506-509. [PMID: 36085144 DOI: 10.1016/j.redare.2021.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 03/01/2021] [Indexed: 06/15/2023]
Abstract
Spontaneous pneumothorax in pregnancy is an extremely rare cause of dyspnea with less than 100 cases reported in the literature. A 28-year-old primigravida at 39+4 weeks of gestation presented to the emergency department with sudden onset of dyspnea and pleuritic chest pain. A chest radiograph revealed a large, left-sided pneumothorax with a collapsed lung. A chest tube was placed with incomplete re-expansion of the lung. A cesarean section under epidural anesthesia was performed for suspected macrosomia. The postpartum was uneventful. Despite its rarity, spontaneous pneumothorax should be excluded in every pregnant woman presenting with sudden onset of dyspnea and chest pain. A heightened index of suspicion is essential for prompt management of this condition, avoiding adverse fetal and maternal outcomes. For a correct diagnosis and management, more solid recommendations and a multidisciplinary approach are needed.
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Affiliation(s)
- M C Cardoso
- Department of Obstetrics and Gynecology, Hospital do Divino Espírito Santo de Ponta Delgada, Azores, Portugal.
| | - M I Raposo
- Department of Obstetrics and Gynecology, Hospital do Divino Espírito Santo de Ponta Delgada, Azores, Portugal
| | - C Gaio-Lima
- Anesthesiology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - P Ferreira
- Department of Anesthesiology, Hospital do Divino Espírito Santo de Ponta Delgada, Azores, Portugal
| | - P Cosme
- Department of Obstetrics and Gynecology, Hospital do Divino Espírito Santo de Ponta Delgada, Azores, Portugal
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Taher A, Qassrawi H, Malhis A, Aburumh H. Bilateral pneumothorax in a parturient undergoing cesarean section under general anesthesia. Saudi J Anaesth 2022; 16:466-468. [DOI: 10.4103/sja.sja_64_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 11/04/2022] Open
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Georgopapadakos N, Lioumpas D, Mpenakis G, Tsochrinis A, Tsarna E. Primary Spontaneous Pneumothorax in a 32-Week Complicated Pregnancy. Cureus 2021; 13:e15037. [PMID: 34150388 PMCID: PMC8202786 DOI: 10.7759/cureus.15037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Primary spontaneous pneumothorax during pregnancy is a very rare entity. We present a 37-year-old Caucasian woman with spontaneous pneumothorax during the 32nd week of her fourth pregnancy who was treated with intercostal chest drain and was followed up with chest ultrasound. The patient experienced two more episodes of recurrent pneumothorax during pregnancy and puerperium and a uniportal video-assisted thoracoscopic surgery (VATS) was performed. Few such cases have been reported previously in the literature, and there are no relevant medical guidelines. Treatment options include surveillance of a collapsed lung, conservative management with intercostal chest drain, and surgical management with the use of VATS.
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Affiliation(s)
| | - Dimitrios Lioumpas
- Thoracic Surgery, General Hospital of Nikaia "Agios Panteleimon", Piraeus, GRC
| | - Georgios Mpenakis
- Thoracic Surgery, General Hospital of Nikaia "Agios Panteleimon", Piraeus, GRC
| | - Alexios Tsochrinis
- Obstetrics and Gynecology, General Hospital of Nikaia "Agios Panteleimon", Piraeus, GRC
| | - Ermioni Tsarna
- Obstetrics and Gynecology, General Hospital of Nikaia "Agios Panteleimon", Piraeus, GRC
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Agrafiotis AC, Assouad J, Lardinois I, Markou GA. Pneumothorax and Pregnancy: A Systematic Review of the Current Literature and Proposal of Treatment Recommendations. Thorac Cardiovasc Surg 2020; 69:95-100. [PMID: 32199405 DOI: 10.1055/s-0040-1702160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Spontaneous pneumothorax occurs rarely during pregnancy with less than 100 cases reported in the English literature. There is no strong evidence concerning the treatment of spontaneous pneumothorax during pregnancy and labor. The aim of this study is to systematically review all the reported cases and to suggest recommendations for its diagnosis and treatment. METHODS A PubMed research was conducted. The following data were collected: maternal age, gestation age (weeks), presence of underlying lung pathology, initial management, definitive management, obstetric outcome, and the complications for the mother and the fetus. RESULTS Eighty-seven cases were identified. The mean maternal age was 27 years (standard deviation [SD] ± 6). The mean gestational age was 25 weeks (SD ± 11.4). In 37.9% of cases, there was no underlying lung disease. In the majority of cases (67.4%), the initial treatment was the placement of a chest tube. In 48% of cases, the pneumothorax was resolved with conservative treatment. Surgical therapy was performed either antepartum or postpartum. In 58.6% of cases, there was a vaginal delivery, spontaneous or instrumental. In three cases (3.4%), there were fetal complications. CONCLUSION The analysis of the current literature provides low evidence, since there are only case reports and small case series. It is likely that the frequency of this condition is underestimated. However, this analysis permits to draw some conclusions concerning the timing of pneumothorax treatment, the operative strategy, and the mode of delivery to decrease the risk for the mother and the fetus.
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Affiliation(s)
- Apostolos C Agrafiotis
- Department of Thoracic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Inès Lardinois
- Department of Thoracic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Georges A Markou
- Department of Obstetrics and Gynecology, René-Dubos Hospital Center, Pontoise, France
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Gahlot D, Saxena K, Wadhwa B. Cesarean section in a parturient with giant lung cyst. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2020. [DOI: 10.4103/joacc.joacc_28_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lateef N, Dawood M, Sharma K, Tauseef A, Munir MA, Godbout E. Recurrent spontaneous pneumothorax in pregnancy - a case report and review of literature. J Community Hosp Intern Med Perspect 2018; 8:115-118. [PMID: 29915647 PMCID: PMC5998285 DOI: 10.1080/20009666.2018.1472514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/24/2018] [Indexed: 11/03/2022] Open
Abstract
Spontaneous pneumothorax in pregnancy is a rare and life-threatening condition. In this report, a case of spontaneous pneumothorax occurring at 34 weeks’ gestation in a healthy 34-year-old primigravida is described. She had typical complaints of chest pain and dyspnoea and diagnosis was made by chest X-ray which showed an extensive pneumothorax in the right side. Pneumothorax recurred twice over approximately three weeks. A caesarean section secondary to small pelvic parameters was scheduled with the chest tube in situ and a healthy 2.5 kg female infant was delivered. We discuss spontaneous pneumothorax during pregnancy and review the literature.
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Affiliation(s)
- Noman Lateef
- Dow University of Health Sciences, Karachi, Pakistan
| | - Mustafa Dawood
- Medicine, Greater Baltimore Medical Center, Towson, MD, USA
| | - Karn Sharma
- Saba University School of Medicine, Saba, Dutch Caribbean
| | | | | | - Erin Godbout
- Medicine, Greater Baltimore Medical Center, Towson, MD, USA
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Pinto RM, Mahankali S, Prasanna BS, Ramkumar MM. Spontaneous pneumothorax in pregnancy: A challenge for anaesthesiologist. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2017. [DOI: 10.4103/joacc.joacc_29_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Antepartum surgical management of Pott’s paraplegia along with maintenance of pregnancy during second trimester. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:1064-9. [DOI: 10.1007/s00586-015-4045-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 05/17/2015] [Accepted: 05/21/2015] [Indexed: 11/24/2022]
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Akçay O, Uysal A, Samancılar O, Ceylan KC, Sevinc S, Kaya SO. An unusual emergency condition in pregnancy: pneumothorax. Case series and review of the literature. Arch Gynecol Obstet 2012; 287:391-4. [DOI: 10.1007/s00404-012-2510-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 07/30/2012] [Indexed: 11/29/2022]
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Nwaejike N, Aldam P, Pulimood T, Giles R, Brockelsby J, Fuld J, Hughes J, Coonar A. A case of recurrent spontaneous pneumothorax during pregnancy treated with video assisted thoracoscopic surgery. BMJ Case Rep 2012; 2012:bcr.05.2011.4282. [PMID: 22891012 DOI: 10.1136/bcr.05.2011.4282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pneumothorax during pregnancy is uncommon. Recently ambulatory chest drainage has been advised to treat the pneumothorax and to cover the delivery period. This imposes restrictions on the mother with associated co-morbidity. The authors present a case of recurrent chest-tube resistant pneumothorax during pregnancy which had persisted for 4-weeks. To guide management of a patient referred in the third trimester of pregnancy the authors undertook a systematic review. This led to definitive video assisted thoracoscopic surgery (VATS) for bullectomy and pleurodesis which was successful without either peri-operative or peri-partum complications or recurrence of pneumothorax. Our review suggests that a VATS approach during pregnancy is both safe and effective.
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Affiliation(s)
- Nnamdi Nwaejike
- Cardiothoracic Surgery Department, Papworth Hospital, Cambridge, UK
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Benson CC, Valente AM, Economy KE, Hoffman-Sage Y, Bevilacqua LM, Podovei M, Opotowsky AR. Discovery and management of diaphragmatic hernia related to abandoned epicardial pacemaker wires in a pregnant woman with {S,L,L} transposition of the great arteries. CONGENIT HEART DIS 2011; 7:183-8. [PMID: 21718459 DOI: 10.1111/j.1747-0803.2011.00547.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Epicardial pacemaker leads placed during childhood are often not removed when transvenous systems are placed later in life. The risk of complications related to retained pacemaker leads and generators is not clear but is generally considered low. We report the case of a 23-year-old pregnant woman who presented with left upper quadrant pain at 20 weeks gestation. The patient was born with {S,L,L} transposition of the great arteries and had high-grade conduction disease in infancy compelling epicardial pacemaker placement. A standard transvenous pacemaker was placed at age 9 years, without removal of the epicardial system. The patient's abdominal pain was attributed to herniation of abdominal contents through a diaphragmatic defect at the site of the abandoned epicardial pacing wire. Her pain improved spontaneously but worsened later in pregnancy leading to repair of the diaphragmatic hernia via anterolateral thoracotomy at 30 weeks gestation. The procedure was well tolerated by mother and fetus. At 38 3/7 weeks gestation, the patient underwent uneventful delivery by cesarean section for breech presentation. This case illustrates the importance of multidisciplinary collaboration in the care of women with congenital heart disease.
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Affiliation(s)
- Craig C Benson
- Combined Internal Medicine-Pediatrics Residency, University of Rochester Medical Center, Rochester, New York, USA
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Anterior, thoracoscopic-assisted reduction and stabilization of a thoracic burst fracture (T8) in a pregnant woman. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20:1217-21. [PMID: 21399932 DOI: 10.1007/s00586-011-1712-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 09/06/2010] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
Abstract
Injuries of the spine in pregnant women are rare. Unstable fractures, incomplete neurological deficits and failed conservative treatment are indications for operative stabilization. So far, only posterior stabilization techniques performed during pregnancy have been published in case reports. This Grand Round case presentation describes a 24-year-old woman in the 19th week of gestation who was involved in a motorcycle accident as a pillion rider. Radiological examination revealed a complete burst fracture (type AO A3.3) of T8 with a slight, yet clinical unapparent narrowing of the spinal canal and a stable T5 fracture (type AO A1.2). Despite analgesia with morphine, conservative treatment failed and it was not possible to mobilize the patient. Hence, an anterior thoracoscopic-assisted reduction and stabilization in left lateral position with single lung ventilation was performed as the therapy of choice. Intraoperatively, the body of T8 was removed and plate was used to stabilize and reduce the fracture. Finally, a tricortical iliac bone graft was implanted into the bony defect. Intraoperative fluoroscopy was merely used to verify the positioning of the implants. Postoperative examination of the foetus revealed normal findings. The patient was discharged with paracetamol as residual pain medication. The degree of kyphosis of the T8 fracture was successfully reduced from 20° to 13° (segmental standard value 12°). Further clinical and radiological course of the patient was uneventful. If suitable implants are available and good bone structure exists, solely anterior thoracoscopic-assisted reduction and stabilization of an unstable thoracic burst fracture can be performed safely. In the present case, it was possible to avoid intraoperative prone positioning of the pregnant patient as well as reaching a minimum of radiation exposure.
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Hu R, Li H, Wang G. Surgical treatment for recurrent spontaneous pneumothorax during twin pregnancy under video-assisted thoracoscopic surgery (VATS). J Thorac Dis 2010; 2:178-9. [PMID: 22263040 DOI: 10.3978/j.issn.2072-1439.2010.02.03.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 08/09/2010] [Indexed: 11/14/2022]
Abstract
Spontaneous pneumothorax during pregnancy is a rare pathological condition. Few cases have been reported previously in the literature. There is no universal guideline for the management of this condition yet. We report a case of recurrent spontaneous pneumothorax during twin pregnancy in a 30-year-old woman. Surgical treatment under video-assisted thoracoscopic surgery (VATS) was successfully performed, without subsequent pneumothorax recurrence.
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Affiliation(s)
- Runlei Hu
- Department of Thoracic Surgery, Hangzhou First People's Hospital, Hangzhou 310006, Zhejiang Province, China
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Pneumothorax and pneumomediastinum in pregnancy: a case report. Obstet Gynecol Int 2009; 2009:465180. [PMID: 20066165 PMCID: PMC2804036 DOI: 10.1155/2009/465180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 07/18/2009] [Accepted: 09/01/2009] [Indexed: 11/18/2022] Open
Abstract
Case Report. A 37 years old patient at 40 weeks gestation presented with acute severe hypoxia with a seizure followed by fetal bradycardia. Caesarean section was performed under GA and she was intubated and ventilated. History revealed longstanding right pleural endometriosis with multiple pneumothoraces and hydrothoraces. A CT chest showed extensive bilateral pnenumothoraces. Her clinical condition improved with a left-sided chest drain. Discussion. Severe hypoxia and seizures in a patient with previous history of pnenumothorax are highly suggestive of tension pneumothorax. Radiological investigations are vital for diagnosis. The traditional treatment approach to recurrent pneumothorax has been thorocotomy with bleb or bulla resection and pleurodeisis. The advantages of thorocoscopic surgical treatment over thorocotomy are decreased time of exposure to anaesthetic drugs, rapid lung expansion, decreased post operative pain, and a potentially shorter post operative recovery. In any future pregnancy due to the high risk of recurrence of pneumothorax Contemporary obstetric management should determine the method of delivery and continuous lumbar/epidural anesthesia should be used if at all feasible. Preconceptual counseling about this risk is vital, and women must be advised about potential serious adverse outcomes.
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Jain P, Goswami K. Recurrent spontaneous pneumothorax during pregnancy: a case report. J Med Case Rep 2009; 3:81. [PMID: 19946557 PMCID: PMC2783080 DOI: 10.1186/1752-1947-3-81] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2008] [Accepted: 10/21/2009] [Indexed: 11/10/2022] Open
Abstract
Introduction Spontaneous recurrent pneumothorax during pregnancy is a rare condition. Few cases have been reported previously in the literature. There is no universal guideline for the management of this condition. Treatment options include conservative management with intercostal drain and surgical management in the form of thoracotomy or video-assisted thoracoscopy. Case presentation We report a case of recurrent spontaneous pneumothorax in a 38-year-old Afro-Caribbean woman on her third trimester of pregnancy. The disease was managed with the insertion of an intercostal drain on three occasions, which was then followed by surgical intervention immediately after pregnancy. Conclusion The diagnosis of pneumothorax should be considered in the differential diagnosis of pregnant women experiencing chest pain and dyspnoea. No adverse maternal or foetal outcome has been reported in well-managed cases. Management involves good coordination between the obstetric and surgical teams.
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Affiliation(s)
- Preeti Jain
- Department of Obstetrics and Gynaecology, University Hospital Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
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Mitsunari H, Yamagata K, Sakuma S. Anesthetic management of thoracotomy for spontaneous pneumothorax in a pregnant woman. Int J Obstet Anesth 2008; 17:85-6. [PMID: 17693074 DOI: 10.1016/j.ijoa.2007.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
BACKGROUND Though more common in male patients, primary spontaneous pneumothorax might be expected to occur reasonably often in female patients of child-bearing age. However, < 50 cases of pneumothorax in pregnancy have been previously reported. Special risks are posed for both the mother and the fetus in this situation. Previous management strategies have varied widely, without describing the more modern and less invasive techniques, and existing pneumothorax guidelines do not incorporate this difficult scenario. METHODS A retrospective search of our database of 250 spontaneous pneumothorax patients over a 10-year period, in a stable local population of 500,000 patients, identified five cases of pneumothorax occurring in pregnancy. We report our experience, the largest series yet described, review the medical literature, and make management recommendations. RESULTS We found favorable outcomes for both mothers and infants in our series, with modern techniques such as simple aspiration, elective assisted delivery at or near term with regional anesthesia, and video-assisted thoracoscopic surgery. CONCLUSIONS Future guidelines on the management of pneumothorax should consider the inclusion of advice on the problems of pregnancy, based on previous published experience, and utilizing the modern and less invasive techniques. Such advice would inform and support those specialists involved in managing a potentially hazardous situation to the benefit of both mother and child.
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Affiliation(s)
- Abhi Lal
- Department of Respiratory Medicine, Castle Hill Hospital, Castle Rd, Cottingham HU16 5JQ, UK
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20
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Liu V, White DA, Zakowski MF, Travis W, Kris MG, Ginsberg MS, Miller VA, Azzoli CG. Pulmonary toxicity associated with erlotinib. Chest 2007; 132:1042-4. [PMID: 17873198 DOI: 10.1378/chest.07-0050] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Interstitial lung disease (ILD) related to therapy with the drug gefitinib has been well reported. The adverse pulmonary effects of erlotinib are less well known. We report a case of fatal pulmonary toxicity in a patient with advanced non-small cell lung cancer who received erlotinib. He had been found to have pathologic findings of usual interstitial pneumonia (UIP) on the resected lung cancer specimen prior to receiving erlotinib. This case and other published evidence should alert physicians to the possibility of fatal erlotinib-induced ILD. Similar to reports in patients receiving gefitinib, those with pathologic findings of UIP on resected lung specimens or known pulmonary fibrosis may be at particular risk for erlotinib pulmonary toxicity.
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Affiliation(s)
- Vincent Liu
- Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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21
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Sills ES, Meinecke HM, Dixson GR, Johnson AM. Management approach for recurrent spontaneous pneumothorax in consecutive pregnancies based on clinical and radiographic findings. J Cardiothorac Surg 2006; 1:35. [PMID: 17052345 PMCID: PMC1624824 DOI: 10.1186/1749-8090-1-35] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Accepted: 10/19/2006] [Indexed: 11/24/2022] Open
Abstract
Objective To describe management and clinical features observed in a patient's seven spontaneous pneumothoraces that developed during two consecutive pregnancies involving both hemithoraces. Materials and methods A 21 year old former smoker developed three spontaneous left pneumothoraces in the index pregnancy, having already experienced four right pneumothorax events in a prior pregnancy at age 19. Results Chest tubes were required in several (but not all) hospitalizations during these two pregnancies. Following her fourth right pneumothorax, thoracoscopic excision of right apical lung blebs and mechanical pleurodesis was performed. The series of left pneumothoraces culminated in mini-thoracotomy and thoracoscopically directed mechanical pleurodesis. For both pregnancies unassisted vaginal delivery was performed with no adverse perinatal sequelae. With the exception of multiple pneumothoraces, there were no additional pregnancy complications. Conclusion Spontaneous pneumothorax in pregnancy is believed to be a rare phenomenon, yet the exact incidence is unknown. Here we present the first known case of multiple spontaneous pneumothoraces in two consecutive pregnancies involving both hemithoraces. Clinical management coordinated with obstetrics and surgical teams facilitated a satisfactory outcome for both pregnancies. The diagnosis of pneumothorax should be contemplated in any pregnant patient with dyspnea and chest pain, followed by radiographic confirmation.
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Affiliation(s)
- Eric Scott Sills
- Department of Obstetrics, Gynecology and Reproductive Research, Murphy Medical Center, Murphy, North Carolina USA
| | - Henry M Meinecke
- Department of Surgery, Murphy Medical Center. Murphy, North Carolina USA
| | - George R Dixson
- Department of Radiology, Murphy Medical Center. Murphy, North Carolina USA
| | - Alan M Johnson
- Asheville Cardiovascular & Thoracic Surgeons, P.A., Asheville, North Carolina USA
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Melo R, Gonçalves JR. Pleurodese. REVISTA PORTUGUESA DE PNEUMOLOGIA 2004; 10:305-17. [PMID: 15492876 DOI: 10.1016/s0873-2159(15)30588-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Pleurodesis is a way of inducting an inflammatory process in the pleural surface in order to create the closure of the pleural space. The exact mechanism isn't completely understood and there is still a great deal of controversy concerning pleurodesis. Pleurodesis can be achieved by introduction of a sclerosant agent trough a chest tube into the pleural space, by medical thoracoscopy, by surgical thoracoscopy or by thoracotomy. The principal sclerosant agents are talc and tetracycline. The indications for pleurodesis are malignant recurrent pleural effusion, primary recurrent pneumothorax, secondary pneumothorax and benign pleural effusion resistant to medical treatment. There are, although, some contraindications to performing it. Serious complications of pleurodesis are rare and depend on the technique and agent used. The method of choice for pleurodesis is related to the experience and technical facilities available. The author presents a review about pleurodesis.
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Affiliation(s)
- Ricardo Melo
- Serviço de Pneumologia, Hospital Santa Maria, Avenida Prof. Egas Moniz, 1699 Lisboa Codex, Portugal.
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23
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Placental Site Trophoblastic Tumor Presenting With a Pneumothorax During Pregnancy. Obstet Gynecol 2002. [DOI: 10.1097/00006250-200211001-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- P Bhatia
- Department of Respiratory Medicine, Blackpool Victoria Hospital, Blackpool FY3 8NR, UK
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25
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26
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Catanzarite V, Cousins L. RESPIRATORY FAILURE IN PREGNANCY. Radiol Clin North Am 2000. [DOI: 10.1016/s0033-8389(22)00127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
Pneumothorax is a rare event during pregnancy. We present two cases of pneumothorax occurring after caesarean section under general anaesthesia, including one tension pneumothorax. We summarise risk factors for developing a pneumothorax during pregnancy and discuss differential diagnosis and the anaesthetic management in the labour ward.
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Affiliation(s)
- J M Harten
- Department of Anaesthetics, South Glasgow University Hospitals NHS Trust, Glasgow, UK.
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Affiliation(s)
- E A Harris
- Department of Anesthesiology, University of Miami, FL 33101, USA.
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Reid CJ, Burgin GA. Video-assisted thoracoscopic surgical pleurodesis for persistent spontaneous pneumothorax in late pregnancy. Anaesth Intensive Care 2000; 28:208-10. [PMID: 10788978 DOI: 10.1177/0310057x0002800217] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A case of persistent spontaneous pneumothorax in the third trimester of pregnancy managed by video-assisted thoracoscopic surgical pleurodesis is presented. Anaesthetic and perioperative considerations are discussed.
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Affiliation(s)
- C J Reid
- Anaesthetic Department, Northern Hospital, Epping, Victoria
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Edenborough FP, Mackenzie WE, Stableforth DE. The outcome of 72 pregnancies in 55 women with cystic fibrosis in the United Kingdom 1977-1996. BJOG 2000; 107:254-61. [PMID: 10688510 DOI: 10.1111/j.1471-0528.2000.tb11697.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify pregnancies in women with cystic fibrosis and describe obstetric, infant and maternal medical outcomes in relation to the severity of maternal disease. DESIGN Retrospective study, based on casenotes. SETTING Eleven cystic fibrosis centres in the United Kingdom. POPULATION Pregnant women with cystic fibrosis. METHODS Single observer medical and obstetric casenote review categorising maternal cystic fibrosis (e.g. genotype, pancreatic, hepatic and diabetic status) and pre-pregnant severity (e.g. weight and lung function) and noting fetal outcome and maternal morbidity. MAIN OUTCOME MEASURES Completed pregnancies and pregnancy losses, fetal outcome and complications, maternal morbidity, such as changes in weight, lung function, pulmonary infections during and after pregnancy. Relation of outcomes to severity of maternal cystic fibrosis. RESULTS From 72 pregnancies identified, the outcomes were known for 69; there were 48 live births (70%) of which 22 were premature (46%); 14 therapeutic abortions (20%); and 7 miscarriages (10%). There were no stillbirths, neonatal or early maternal deaths. Three major fetal anomalies were seen, but no infant had cystic fibrosis. At the conclusion of our study three pregnancies were still continuing. Prematurity with increased fetal complications and maternal morbidity with infection, declining lung function and poor weight gain were associated with poor pre-partum lung function. CONCLUSION Pregnancy occurs in women with cystic fibrosis of all degrees of severity. Outcomes for the infant are generally good but are variable for the mother. Predicting outcome on the basis of maternal severity is difficult but lung function appears to be the most significant determining factor. Pregnancy may be normal in women with normal lung function (forced expiratory volume > 80%). However, it may adversely affect mild and moderate lung disease due to cystic fibrosis and should be avoided in pulmonary hypertension, cor pulmonale and when forced expiratory volume < 50% predicted. Ideally, all pregnancies should be planned with prior counselling and monitored by dedicated cystic fibrosis teams, including obstetricians who are experienced in managing high risk pregnancies.
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Affiliation(s)
- F P Edenborough
- Department of Respiratory Medicine, Birmingham Heartlands Hospital, UK
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Butler JA, Restrick LJ, Esmond GM, Mickelsons C, Empey DW. Pregnancy assisted by nasal intermittent positive pressure ventilation in a patient with cystic fibrosis. J R Soc Med 1997; 90:222-3. [PMID: 9155760 PMCID: PMC1296222 DOI: 10.1177/014107689709000412] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- J A Butler
- Royal Hospitals Centre for Cystic Fibrosis, London, England
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